Research on mental health literacy: what we know
and what we still need to know
Anthony F. Jorm, Lisa J. Barney, Helen Christensen, Nicole J. Highet, Claire M. Kelly,
Betty A. Kitchener
Australian and New Zealand Journal of Psychiatry 2006; 40:3–5
The term mental health literacy was first introduced in
1997 and defined as ‘knowledge and beliefs about mental
disorders which aid their recognition, management and
prevention’ [1]. The aim in coining this term was to draw
attention to a neglected area. Whereas the public know a
lot about other major health problems such as cancer and
heart disease, they lack the same degrees of knowledge
about mental disorders [2]. Since then, the term mental
health literacy has come into widespread use in Australia
and it has appeared as a national goal in a number of pol-
icy documents [3,4]. The concept has also spawned quite
a bit of research and it is the purpose of the present paper
to summarize what we have learned since 1997 and what
we still need to know. The summary below draws mainly
on Australian research and particularly on the series of
papers published in the current issue of the journal. Al-
though a number of researchers in other countries started
up similar lines of work at around the same time [5], this
is arguably an area in which Australia has had a leading
role.
Anthony F. Jorm, Professor (Correspondence); Lisa J. Barney, Postgraduate
student; Helen Christensen, Professor and Director; Claire M. Kelly, ARHRF
Hugh Lydiard Fellow; Betty A. Kitchener, Mental Health First Aid Program
Director
Centre for Mental Health Research, Australian National Univer-
sity, Canberra, Australian Capital Territory 0200, Australia. Email:
ajorm@unimelb.edu.au
Nicole J. Highet, Senior Program Manager
beyondblue: the national depression initiative, Victoria, Australia
What we know
Mental disorders are not well recognized by the
public
The initial Australian survey of mental health literacy
showed that many people cannot give the correct psy-
chiatric label to a disorder portrayed in a depression or
schizophrenia vignette [1]. Although this situation has
since improved [6], there is still much room for improve-
ment. Lack of appropriate recognition of disorders in
oneself or others may lead to delays in seeking help and
inappropriate help-seeking.
There is a gap between public and professional
beliefs about treatment
There is a consensus among mental health profes-
sionals about the appropriate treatments for depression
and schizophrenia [7]. However, the public do not al-
ways share a belief in these treatments. The biggest gap
is in beliefs about medication for both depression and
schizophrenia, and admission to a psychiatric ward for
schizophrenia. These gaps may lead to a lack of appropri-
ate help-seeking and a failure to adhere to recommended
treatments. Ultimately, they may be an impediment to the
implementation of evidence-based health care.
Stigma is a barrier to help-seeking
Inadequate knowledge is not the only factor limiting
help-seeking. Negative attitudes are important as well.
4 EDITORIAL
Such negative attitudes can involve self stigma in which
a person has internalized the negative attitudes held by
society and applied these to themselves, or it can be per-
ceived stigma which involves the belief that others hold
stigmatizing attitudes. Both of these are widespread and
reduce the likelihood of a person who is depressed seek-
ing professional help [8].
First aid skills are deficient
Because of the high prevalence of mental disorders,
members of the public have a high probability of having
close contact with someone developing a mental disorder
or in a mental health crisis situation. How they respond
may make a difference to whether the person gets profes-
sional help and feels supported by their social network.
Such responses may be most critical for young people
when they are first developing a disorder. Unfortunately,
first aid skills are deficient. Many adolescents do not
know how to respond to a friend’s distress in a way that
will facilitate appropriate help [9], and adults also have
deficiencies in first aid skills [10].
There are several types of interventions that can
improve mental health literacy
All of the above is quite negative, but research offers
much hope. There is growing evidence that mental
health literacy can be improved, both by population-
wide interventions and individual training programs. At
the population level there is evidence that beyondblue: the
national depression initiative has contributed to some
positive changes [11,12] and, at the individual level, men-
tal health first aid training and websites giving either
good-quality information or cognitive–behavioural skills
have been shown to be effective in randomized trials
[13–15].
Mental health literacy is improving in the Australian
population
Since the initial survey of mental health literacy in
Australia in 1995, there have been some major im-
provements. Recognition of disorders in vignettes has
increased substantially and beliefs about treatments have
changed, including for medications [6]. There has also
been an increase in awareness and knowledge about de-
pression specifically [11,16]. In general, public beliefs
have become closer to those of health professionals. be-
yondblue has been one contributor to this improvement,
but there are undoubtedly many other influences.
What we still need to know
How can we reduce stigma?
Changing knowledge is something that is in principle
not difficult. As a society we do it all the time. However,
changing deep-seated emotional reactions to mental dis-
orders may be much harder. Despite stigma being one
of the major concerns of patients, we know very little
about how to reduce it. It is possible that by increasing
knowledge we will also succeed in reducing stigma by
overcoming misconceptions. However, given that clini-
cians are people with high mental health literacy, but not
necessarily low in stigmatizing attitudes [17], it is clear
that the two do not necessarily go together. Neverthe-
less, there is some evidence that mental health literacy
interventions do have a small impact on reducing social
distance and stigma [13,15]. However, we need to do
much better.
Has improved mental health literacy changed
people’s help-seeking behaviour?
There are various strands of evidence indicating that
changing knowledge and beliefs about mental disorders
will influence behaviour [18]. However, we need to know
what is occurring at the population level. Has the in-
creased belief in the value of help-seeking led to an in-
crease in actual help-seeking? Similarly, has the increase
in belief in antidepressants been, at least in part, respon-
sible for the rise in antidepressant prescribing? And has
adherence to evidence-based treatments increased?
Can we increase preventive action and early
intervention?
Arguably, the key areas for action are prevention and
early intervention with first-onset disorders. What can
improved mental health literacy contribute to these aims?
With major physical health problems like cancer and heart
disease, there are population-wide health promotion pro-
grams to reduce risk factors and promote early detection.
This sort of work has not occurred with mental disorders
except on a limited basis. There have been efforts to re-
duce the duration of untreated disorders in young people,
such as the Compass Strategy in Victoria [19]. There has
been even less action to improve public knowledge of
how to prevent mental disorders. It would be possible
to disseminate information on how to modify one’s own
risk or the risk to others, and on effective self-help and
first-aid strategies.
 EDITORIAL
Does mental health literacy improve population
mental health?
7.
The ultimate question is whether improved mental
health literacy leads to improved mental health. Again,
at the individual level there is some tantalizing evidence
8.
that it can. Both Mental Health First Aid training and
the BluePages website have been found to produce ther-
apeutic effects [13,15], even though both simply aim to 9.
improve mental health literacy and do not provide any
therapy. However, will this be translated into gains at the 10.
population level? In Australia, we have not even begun
systematically monitoring population mental health over
time, so how would we know? Such a situation would
11.
be unthinkable with cancer and heart disease. We need
to begin population monitoring of knowledge, attitudes,
help-seeking behaviours and mental health.
12.
References
1. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, 13.
Pollitt P. “Mental health literacy”: a survey of the public’s
ability to recognise mental disorders and their beliefs about the
effectiveness of treatment. Medical Journal of Australia 1997; 14.
166:182–186.
2. Jorm AF. Mental health literacy: public knowledge and beliefs
about mental disorders. British Journal of Psychiatry 2000; 177:
396–401. 15.
3. Commonwealth Department of Health and Aged Care. National
action plan for promotion, prevention and early intervention for
mental health. Canberra: Mental Health and Special Programs 16.
Branch, Commonwealth Department of Health and Aged Care,
2000.
4. Commonwealth Department of Health and Aged Care. National 17.
action plan for depression. Canberra: Mental Health and Special
Programs Branch, Commonwealth Department of Health and
Aged Care, 2000. 18.
5. Jorm AF, Angermeyer M, Katschnig H. Public knowledge of
and attitudes to mental disorders: a limiting factor in the optimal
use of treatment services. In: Andrews G, Henderson AS, eds.
Unmet need in psychiatry. Cambridge: Cambridge University
Press, 2000:399–413. 19.
6. Jorm AF, Christensen H, Griffiths KM. The public’s ability to
recognize mental disorders and their beliefs about treatment:
5
changes in Australia over 8 years. Australian and New Zealand
Journal of Psychiatry 2005; 40:35–40.
Jorm AF, Korten AE, Jacomb PA, Rodgers B, Pollitt P. Beliefs
about the helpfulness of interventions for mental disorders: a
comparison of general practitioners, psychiatrists and clinical
psychologists. Australian and New Zealand Journal of
Psychiatry 1997; 31: 844–851.
Barney LJ, Griffiths KM, Jorm AF, Christensen H. Stigma about
depression and its impact on help-seeking intentions. Australian
and New Zealand Journal of Psychiatry 2005; 40:51–54.
Kelly CM, Jorm AF, Rodgers B. Adolescents’ responses to
peers with depression or conduct disorder. Australian and New
Zealand Journal of Psychiatry 2005; 40:60–65.
Jorm AF, Blewitt KA, Griffiths KM, Kitchener BA, Parslow
RA. Mental health first aid responses of the public: results from
an Australian national survey. BMC Psychiatry 2005;
5: 9.
Highet NJ, Luscombe G, Davenport TA, Burns JM, Hickie IB.
Positive relationships between public awareness activity and
recognition of the impacts of depression in Australia. Australian
and New Zealand Journal of Psychiatry 2005; 40:54–57.
Jorm AF, Christensen H, Griffiths KM. The impact of
beyondblue: the national depression initiative on the Australian
public’s recognition of depression and beliefs about treatments.
Australian and New Zealand Journal of Psychiatry 2005; 39:
248–254.
Kitchener BA, Jorm AF. Mental health first aid training: review
of evaluation studies. Australian and New Zealand Journal of
Psychiatry 2005; 40:6–8.
Christensen H, Griffiths K, Groves C, Korten A. Free range
users and one hit wonders: community users of an
Internet-based cognitive behaviour therapy program. Australian
and New Zealand Journal of Psychiatry 2005; 40:58–61.
Christensen H, Griffiths KM, Jorm AF. Delivering interventions
for depression by using the Internet: randomised controlled trial.
British Medical Journal 2004; 328: 265.
Highet NJ, Hickie IB, Davenport TA. Monitoring awareness of
and attitudes to depression in Australia. Medical Journal of
Australia 2002; 176 (Suppl):S63–S68.
Hocking B. Reducing mental illness stigma and discrimination –
everybody’s business. Medical Journal of Australia 2003; 178:
S47–S48.
Jorm AF, Medway J, Christensen H, Korten AE, Jacomb PA,
Rodgers B. Public beliefs about the helpfulness of interventions
for depression: effects on actions taken when experiencing
anxiety and depression symptoms. Australian and New Zealand
Journal of Psychiatry 2000; 34: 619–626.
The Compass Strategy. Newsletter No. 2, October 2001.
Department of Psychiatry, University of Melbourne and MH
SKY Youth Program.